Explaining the New Obamacare Provisions

September 29, 2013 at 12:00 AM EST

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Sarah Kliff of the Washington Post clarifies how, exactly, Americans' healthcare will be affected as a result of provisions in the Patient Protection and Affordable Care Act going into effect on October 1, 2013.

HARI SREENIVASAN: Of course one of the big sticking points in the budget talks in Washington is whether Congress should fund the President’s signature piece of legislation, the health care overhaul known as the Affordable Care Act. Tuesday, as you know, is when insurance exchanges are set open across the nation. But three and a half years after the bill became law millions of Americans say they are still confused about how the legislation will affect their lives. To try and help clarify, we’re joined from Washington by Sarah Kliff; she covers health care policy issues for The Washington Post. Thanks so much for joining us.

First of all, these exchanges on Tuesday, who does that effect?

SARAH KLIFF: It’s actually a very small group of Americans. The White House expects that about seven million people will buy insurance on these new exchanges where people who don’t have insurance right now can go and compare plans and potentially purchase an option. The people who are not affected are people who get insurance right now through their employer or people who are on Medicare or Medicaid or number of other government programs.

HARI SREENIVASAN: And that’s the vast majority of Americans?

SARAH KLIFF: It is. We’re actually talking about a pretty small segment of the population for all the debate we’re having here in Washington. At their height the budget forecasters estimate that about seven percent of Americans will use these exchanges. So we’re talking about a sliver of the American population.

HARI SREENIVASAN: This might be a question into retail psychology, but are people likely sign up and purchase something so far in advance because they don’t technically have to have insurance until next year right?

SARAH KLIFF: Everyone I talk to says that they are not; that though the exchanges open on Tuesday don’t expect a wave of enrollment. The White House has been saying again and again in recent weeks that this is a six month open enrollment and October 1 is the very first day. But we’re really not expecting people to sign up until maybe December or even March when open enrollment ends.

HARI SREENIVASAN: So the administration has gone out and made these very simple, easy-to-understand, analogies that buying insurance; it’s like comparing prices on Kayak.com or Expedia. Is it as easy to compare health insurance information in exchanges as it is to purchase a plane ticket?

SARAH KLIFF: No, I don’t think it will be and I think that makes sense. Buying a health insurance policy is more complex and a bigger financial decision than buying a plane ticket somewhere. And you’re dealing with complex terms like copayments and deductibles. The people that I talk to on the ground and in the states who are really setting this up, they sometimes worry that when we’re comparing it to purchasing a plane ticket that you’re setting expectations too high. It might take a number of people a few visits to the website; they might need to find in-person help. The expectation is that it will actually be more complex than buying a plane ticket.

HARI SREENIVASAN: What’s behind a recent surge in corporations using the ACA as a tool to reduce the amount of coverage they’re providing their employees?

SARAH KLIFF: You do see this a little bit, but I wouldn’t say it’s a surge quite yet. You do see some limited stories. Trader Joe’s, for example, the grocery store, has decided that its part-time employees will no longer get coverage instead they will move to these new marketplaces. The calculus on the part of Trader Joe’s and other companies is that now people can get subsidized insurance from the federal government and no one will be denied coverage for a pre-existing condition. And that means they can shift some of their cost toward the federal government. There’s obviously a lot of frustration on the part of Trader Joe’s employees, other employees of companies who have done this. But I do think that you will see more companies moving in this direction now that the individual market doesn’t have pre-existing conditions, or won’t have pre-existing conditions in January. It’s a more appealing place for employees to move some of their workers.

HARI SREENIVASAN: Is the exchange the place that people can go for additional help if they need it or to get additional coverage?

SARAH KLIFF: If you are buying insurance for yourself, let’s say you don’t have insurance right now or if your employer has notified you that you are no longer going to get coverage; starting on Tuesday individuals can go to the marketplace and create an account and basically look at different insurance options. If you’re below a certain income the federal government might give you some subsidies to help buy it to make insurance a little more affordable.

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